Provider Demographics
NPI:1356710321
Name:GATHERS, MICHAEL (BSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GATHERS
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 GLENBROOK RD
Mailing Address - Street 2:FL 2
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06906-2119
Mailing Address - Country:US
Mailing Address - Phone:203-909-5731
Mailing Address - Fax:
Practice Address - Street 1:60 PALMERS HILL RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2113
Practice Address - Country:US
Practice Address - Phone:203-629-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT$$$$$$$$$Medicaid